Women who consume large amounts of alcohol are also more likely to engage in risky reproductive behavior, increasing their likelihood of unplanned pregnancies, interpersonally transmitted infections (Leigh, 1999;O'Hare, 1998), and fetal alcohol exposure (Streissguth et al., 1994). The National Institute on Alcohol Abuse and Alcoholism recently reported an increase in heavy episodic drinking in college students (Hingson et al., 2009). Understanding appetitive decision-making in young women of reproductive age could inform appropriate intervention for this increasingly at-risk group. In particular, more specific knowledge is needed regarding the interaction between alcohol and the brain processes underlying motivated decision making that may bias alcohol-dependent women towards risky behavior. Young adulthood is a critical time during which not only reproduction most often occurs, but alcohol dependence and frontal neural systems underlying decision making develop, suggesting a possible interaction between the two developmental processes. The current study investigates the hypothesis that altered functional neuroanatomy of the prefrontal-limbic system is an important link between alcohol abuse and risky reproductive behavior. Furthermore, a woman's hormonal state is likely to be a relevant factor mediating alcohol and brain interactions, possibly creating windows of acute vulnerability for young women and their potential offspring. Recent evidence suggests that the prefrontal-limbic reward system differs functionally across a woman's menstrual cycle during appetitive decision-making (Rupp et al., 2009). Specifically, women evaluating novel male faces exhibited more neural activation in the orbitofrontal cortex when tested during ovulation as compared to the luteal phase of the cycle. We hypothesize that alcohol-dependent young women have a more sensitized reward brain circuitry in general, and that the hormonal state close to ovulation further enhances vulnerability to risk taking. Using functional magnetic resonance imaging (fMRI) we will examine the neural activation patterns of 20 alcohol-dependent and 20 nondependent young women in response to rewarding stimuli, including pictures of alcohol, male faces, and food. In order to test for effects of hormonal status, we will test naturally cycling women at two phases across their menstrual cycles, including during the follicular phase when a woman is most likely to conceive. We predict that alcohol-dependent women will demonstrate greater neural activation in brain regions associated with reward and less activation in brain regions related to behavioral inhibition, and that the difference will be especially pronounced around ovulation. The ability to balance between the risk and reward of potential appetitive situations and partners is imperative for the safety of young women and their potential offspring. An understanding of menstrual cycle interactions with neural activation and reproductive decision making in alcohol-dependent and non dependent women can enhance our ability to intervene to promote safer appetitive behavior in at-risk young women. PUBLIC HEALTH RELEVANCE: Young alcohol-dependent women demonstrate changes in brain function that may bias them towards risky reproductive decision-making. Unplanned pregnancies in women who consume large amounts of alcohol have long-term negative consequences for infants prenatally exposed to alcohol. An understanding of the functional neuroendocrinological changes that occur with alcohol-dependence, such as sensitization of neural systems associated with the appraisal of risk and reward, are critical to promote optimal appetitive decision-making in young women of reproductive age to protect them and their offspring from the adverse effects of alcohol exposure.